Eurolepto 2012

REGISTRATION FORM

Please complete Registration Form:

Last name
Middle name
First name
Title: Prof Dr Mr Ms Mrs
Institution
Mailing address
City
Zip/Postal Code
Country
Telephone
Fax
E-mail
	Carefully enter your email address.
Accompanying person:
Mr Mrs Last name First name

Registration Fees

	EARLY Before 3 March, 2012		LATE After 3 March, 2012		ON SITE
	Euro	Kuna	Euro	Kuna	Euro	Kuna
Participants	300 €	2200 kn	400 €	3000 kn	400 €	3000 Kn
Students*	180 €	1300 kn	260 €	2000 kn	260 €	2000 Kn
Accompanying person	180 €	1300 kn	260 €	2000 kn	260 €	2000 Kn
Watt included *Students must provide the letter from their head of department to support their application for a student rate

Bank Account (EURO):
Name of Bank: Zagrebacka banka
Address of Bank: Zagreb, Savska 60
Swift Code: ZABAHR2X
IBAN: HR1723600001101354554

Remittance information:
317-08 EURO LEPTO- LAST NAME OF THE PARTICIPANT

Bank Account (KUNA):
ZAGREBAČKA BANKA ZAGREB
ŽIRO RAČUN: 2360000-1101354554

Svrha plaćanja: 317-08- OIB UPLATITELJA- PREZIME UPLATITELJA

Once you have submitted your online registration form, please send us the payment confirmation by e-mail (scanned) or by fax.

Fax number: + 385 1 2390207
Scanned image to: eurolepto2012@vef.hr

Registration is effective only after receipt of the total amount due.